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E3 Journal of Medical Research

E3 Journal of Medical Research Vol. 8 (1) pp. 001-016, February 2021; © E3 Journals; ISSN 2276-9900

Diagnosis associated with COVID-19 (U07.1), Pneumonia- Unspecified (J18.9) and other types of admissions: A restricted medical scheme case study- South Africa

Michael Mncedisi Willie1 * , Asnath Motsepe2
1 Policy Research and Monitoring, Council for Medical Schemes, Pretoria, South Africa
2 Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
*Corresponding Author E-mail:
Accepted 30 January 2021


The primary objective of this study was to assess the characteristics of patients admitted for COVID-19, ′J18.9 Pneumonia, unspecified organism′ and other types of diagnoses. The aim was to assess as to what extent do COVID-19 related admissions changed to pneumonia, and as to what extent do ′J18.9 Pneumonia, unspecified organism′ related admissions that changed to COVID-19 diagnosis at discharge stage. The secondary objective of the study was to assess′ predictors of readmissions in private hospitals. The review period was private hospital claims received by the scheme between January and August 2020. The inclusion criteria for COVID-19 admissions were patients that had a laboratory-confirmed (RT ? PCR assay) COVID-19. Predictors of readmissions were modelled using logistic regression. The study found that restricted scheme patients admitted for a COVID-19 diagnosis changed to a ′J18.9 Pneumonia, unspecified organism′ diagnosis. The converse was found to be true in that some patients that were admitted as J18.9 Pneumonia, unspecified organism′ diagnosis changed to a COVID-19 diagnosis. This study showed underlying factors associated with hospital admissions and predictors of readmissions in private hospitals.

Keywords: COVID-19, Diagnosis, Hospitalisation, ICD-10, Pneumonia, Risk factors

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